Behavioral Activation and Medication Optimization for Perioperative Mental Health in Orthopedic Surgery
Overview
- Phase
- Not Applicable
- Intervention
- Behavioral activation
- Conditions
- Orthopedic Surgery
- Sponsor
- Washington University School of Medicine
- Enrollment
- 116
- Locations
- 1
- Primary Endpoint
- PHQ-ADS
- Status
- Completed
- Last Updated
- 23 days ago
Overview
Brief Summary
This Hybrid 1 Study will test the effectiveness of a bundled intervention comprised of behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing Orthopedic surgery (compared with usual care), while examining implementation outcomes.
Investigators
Ryan Calfee, MD
Professor of Orthopaedic Surgery
Washington University School of Medicine
Eligibility Criteria
Inclusion Criteria
- •Adults ≥ 60 years
- •Scheduled primary hip or primary knee arthroplasty procedure
- •PHQ-ADS ≥ 10, indicating clinically significant depression or anxiety symptoms
Exclusion Criteria
- •Barrier to communication (Unable to read, speak, and understand English)
- •Severe cognitive impairment screened by the SBT (Short Blessed Test) \>10
- •Acutely suicidal
- •Previous participation in this study or another CPMH study of the intervention bundle or its feasibility.
Arms & Interventions
Behavioral activation and medication optimization
Behavioral activation (BA) will begin perioperatively and will span across 3 months postoperatively, with sessions approximately weekly or biweekly, depending on patient preference \& health condition. Medications will be reviewed by a team of interventionists to minimize brain-toxic medications and optimize doses of antidepressants and other mental health medications. In-hospital and after discharge, the interventionists' role will include coordinating with the care teams to ensure that medication changes that were introduced preoperatively are maintained.
Intervention: Behavioral activation
Behavioral activation and medication optimization
Behavioral activation (BA) will begin perioperatively and will span across 3 months postoperatively, with sessions approximately weekly or biweekly, depending on patient preference \& health condition. Medications will be reviewed by a team of interventionists to minimize brain-toxic medications and optimize doses of antidepressants and other mental health medications. In-hospital and after discharge, the interventionists' role will include coordinating with the care teams to ensure that medication changes that were introduced preoperatively are maintained.
Intervention: Medication optimzation
Control (treatment as usual)
Participants in control arm will continue care as usual. They will receive printed resources for supporting sleep hygiene, stress reduction, cognitive and mental health exercises, as well as community resources for older adults.
Intervention: Care as usual
Outcomes
Primary Outcomes
PHQ-ADS
Time Frame: 3 months post-operatively
PHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale) scores will be compared between the two study arms 3 months after surgery. PHQ-ADS is a composite measure of anxiety and depression. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety)
PHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale)
Time Frame: Baseline and 3 months post-operatively
Change in PHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale) scores from baseline to 3 months postoperatively will be compared between the two study arms 3 months after surgery. PHQ-ADS is a composite measure of anxiety and depression. PHQ-ADS scores can range from 0 to 48 (with higher scores indicating more severe depression/anxiety)